Santa Clara County teenagers in mental-health crisis can now access inpatient hospital beds within the county's borders at a new hospital in San Jose, but the county is still eyeing ways to offer more comprehensive services.

On Tuesday, the Santa Clara County Board of Supervisors unanimously approved an agreement with San Jose Behavioral Health, which opened in early 2016 and added a 17-bed inpatient psychiatric unit for 14- to 17-year-olds in August. The beds are available to patients on Medi-Cal and commercial insurance as well as those who are unsponsored or uninsured.

The agreement followed a failed Request for Proposal (RFP) that the county issued last year to find a provider to open a child and adolescent unit in Santa Clara County. The final vendors, California nonprofit EMQ Families First and Alameda-based Telecare Corporation (the two organizations responded jointly to the RFP), "identified the need for additional funding to develop the facility," which the county ultimately was not able to provide within the budget constraints of the original Request for Proposal, Director of Behavioral Health Services Toni Tullys wrote in a staff report.

"The vendor was asked to make their last and final offer within the RFP budget, which they were unable to do, given facility costs," Tullys wrote.

The county closed the RFP on Jan. 10.

Supervisor Joe Simitian, who has been at the forefront of the effort to bring hospital beds for teenagers to Santa Clara County over the last several years, told the Weekly Wednesday that the agreement with San Jose Behavioral Health was one part of but not the full-fledged solution he would like to see. He is continuing conversations with several local health care providers who responded to an earlier Request for Information (RFI), including Palo Alto's Lucile Packard Children's Hospital, Mountain View's El Camino Hospital and Kaiser Permanente, who together submitted a preliminary joint proposal for an 18-bed facility that would serve 12- to 17-year-olds at El Camino's Mountain View campus.

The "legalistic," formal Request for Proposal process came with constraints that didn't "provide a lot of room for the kind of give and take and the kind of collaborative partnership" Simitian sees as the solution to the scarcity of inpatient psychiatric care for teens in Santa Clara County.

"If we see this as a shared responsibility, I think anything is possible," he said. "I think what it's going to take is a collaborative model that is a little more creative than the contracting process ordinarily accommodates."

He said the partnership with San Jose Behavioral Health is "a start, but to me, it's just a start."

Rob March, San Jose Behavioral Health's chief executive officer, told the board that the agreement "will expand access and care to mental health services for adolescents in a significant way."

At Tuesday's Board of Supervisors meeting, however, Supervisor Cindy Chavez also expressed concern about the scope of services that San Jose Behavioral Health provides. She requested that staff produce a report by the end of the week that lists all medical services offered at the hospital. (Simitian said there were concerns about adolescents who need both mental and physical health care while hospitalized.)

She also requested that staff return to the Health and Hospital Committee in several months with options for the county's long-term role in providing inpatient hospitalization services for teenagers with potential partner agencies.

Also "uncomfortable" with the fact that San Jose Behavioral Health was the single bidder for the county, Chavez made a motion, supported by her colleagues, to understand "whether or not the county in partnership with the current proposer or other proposers can come to us with a better, more efficient use of dollars with a more expanded suite of services."

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